| NPI | 1295563765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA LINDA PHELPS Owner 606-307-3918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2024-07-25 |