| NPI | 1396572855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HEISE Owner 386-235-1489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-10-15 |