| NPI | 1154047553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE SHAMELL Billing Manager 888-585-5510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2022-10-17 |