| NPI | 1053942060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIDA LATIF Owner 269-548-9602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2023-02-07 |