| NPI | 1437936812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY L WASHINGTON Program Manager Ii 669-219-4252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2023-09-11 |