| NPI | 1053062539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL DEFEO Physician Owner 551-815-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-01-16 |
| Last Update Date | 2022-12-14 |