| NPI | 1417716028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA PATRICIA BALINDA-KAMANYIRE Member 800-419-6960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2025-03-14 |