| NPI | 1093433674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK GREER Owner 727-300-0405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2024-08-28 |