| 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 |