| NPI | 1184369936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FANTA SCHWARZ Provider/Owner 267-879-6292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261Q00000X Clinic/Center | |
| 261QP2300X Clinic/Center, Primary Care | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2022-07-18 |