| NPI | 1093438384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY BLAIR ELDER Revenue Cycle Administrator 737-247-1223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2024-02-01 |