| NPI | 1164398137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX MATHER Chief Administrative Officer 855-621-2061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2025-10-15 |