| NPI | 1255976874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LYLE Billing Specialist 672-123-6266 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-11-07 |