| NPI | 1336885227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH MONIQUE DENNIS Owner 754-300-9290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2024-09-26 |