| NPI | 1386135762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLOLENE ALLAN Owner 385-645-7474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 211972-4405) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2019-02-14 |