| NPI | 1285168450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAINE MCCUNE Credentialing Coordinator 567-585-1964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2022-07-21 |