| NPI | 1265251813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAS DEWAYNE CARTER Chief Administrator & Compliance 725-204-9155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2026-06-02 |