| NPI | 1124633995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES SAMUEL FILLINGANE Owner 660-220-2123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2025-02-18 |