| NPI | 1053454587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYODE O ATOLOYE Program Administrator 877-467-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-22 |