| NPI | 1407362395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE SHANKS Owner 808-825-0190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X |
| 261QH0100X Clinic/Center, Health Services | |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2019-12-12 |