| NPI | 1467943571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK L ANDERSON Financial Officer 844-362-8255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2018-10-23 |