| NPI | 1386408706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE LECLAIR SPENCER Owner 863-873-0072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2024-03-04 |