| NPI | 1194273524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN BARTON Aprn 385-218-9649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: UT 70107323102) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-09-14 |