| NPI | 1295386936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARICELJEAN RYCRAFT Managing Employee 725-214-1009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2023-02-15 |