| NPI | 1336773720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM HARPER Owner 855-947-7371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-02-25 |