| NPI | 1396291944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM ANTOINETTE MITCHELL-SILVER Owner/Administrator 769-242-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS 1095115) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2019-06-11 |