| NPI | 1053195164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA SEISAY Owner 980-210-6520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 251C00000X |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2023-08-21 |