| NPI | 1215487111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA RAGER Director Revenue Cycle 844-969-0686 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2025-01-10 |