| NPI | 1275173403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY TYRONE WHIGHAM Chief Operating Officer 833-687-8223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2020-01-15 |