| NPI | 1063378271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BLAKEBURN Owner 580-445-0773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-12-31 |
| Last Update Date | 2026-01-09 |