| NPI | 1144802620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIA COLLETON-LIVINGSTON Nurse Practitioner 980-288-4783 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2021-04-24 |
| Last Update Date | 2025-07-18 |