| NPI | 1346002763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT WILLIS Medical 754-242-1876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-02-12 |