NPI | 1194586461 |
---|---|
Entity Type | Organization |
Authorized Contact | MONYA YORK Controller 870-856-1202 |
Organization Subpart ? | No |
Primary Taxonomy | 208000000X Pediatrics |
Additional Taxonomies | 207Q00000X Family Medicine |
261QR1300X Clinic/Center, Rural Health | |
Enumeration Date | 2024-01-23 |
Last Update Date | 2024-01-23 |