| NPI | 1427520618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICK HIBBEN Manager, Regulatory Compliance 866-546-6893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2018-12-28 |