| NPI | 1275392573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 833-759-8720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2025-07-16 |