| NPI | 1417687112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD ANDREW THAMES President 800-997-6196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2024-10-16 |