| NPI | 1386245702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL MCKENNA Director 844-362-3425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2023-05-18 |