| NPI | 1154573095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA K RAYNER-STOKES Owner 228-864-0622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2008-10-22 |