| NPI | 1205372935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA LEE Admin 800-348-4623 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QB0400X Clinic/Center, Birthing |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2019-12-16 |