| NPI | 1063301612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA FOMBUH Owner/Provider 047-741-2909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-06-30 |