NPI | 1295461663 |
---|---|
Entity Type | Organization |
Authorized Contact | TERRI TYE Billing And Credentialing 606-215-3832 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice |
Additional Taxonomies | 261Q00000X Clinic/Center |
Enumeration Date | 2022-07-28 |
Last Update Date | 2023-10-11 |