| NPI | 1104363035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE DURANT Nurse Pratitioner 844-708-4822 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MD R149803) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |