| NPI | 1508336330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN TAYLOR Owner 346-570-2625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2019-07-19 |