| NPI | 1053838904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT L CARTER CEO 866-678-4003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171W00000X Contractor |
| 261Q00000X Clinic/Center | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2017-08-23 |