| NPI | 1447971916 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | ANDREA CHADWICK Medical Director 800-924-7811  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty | 
| Additional Taxonomies | 261Q00000X Clinic/Center | 
| Enumeration Date | 2022-09-05 | 
| Last Update Date | 2024-06-24 |