| NPI | 1124685169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID FAIRCHILD President And Chief Medical Office 877-868-5351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2023-10-26 |