| NPI | 1518788959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON HOLLIS Owner 276-591-8383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-10-18 |
| Last Update Date | 2024-11-24 |