| NPI | 1316275084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK L. SMITH Medical Director 877-240-3645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 00G01780) |
| 235Z00000X Speech-Language Pathologist (Licence: CA SP5393) | |
| 247100000X Radiologic Technologist (Licence: CA 435293) | |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2022-07-21 |