| NPI | 1255015830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOMER D DEBERRY Care Coordinator/Co Owner 262-720-0203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-06-14 |