| NPI | 1114531001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA MARKS CEO 606-408-4401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2023-06-16 |