| NPI | 1497940803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN D STARKS Claims Assistant 0118146-816-8574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2007-09-09 |
| Last Update Date | 2008-04-20 |