| NPI | 1275392573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 855-380-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2024-10-03 |