| NPI | 1508636945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE MARIE GOODRICH Owner 765-865-0135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2025-01-29 |