| NPI | 1154895878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON WATT CEO 772-208-3057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2026-03-30 |