| NPI | 1538359922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN DISHON STARKS Claims Assistant 0118146-806-8574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2007-07-31 |