| NPI | 1053797670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP THOMPSON CEO 754-234-0536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 30211788) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2018-06-22 |