| NPI | 1386268555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN MARTIN Provider 833-479-6325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2022-05-18 |