| NPI | 1083236137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY MORENO- SILVA President 276-252-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2022-03-28 |