| NPI | 1447839196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN COOPER Manager 877-495-7773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |