| NPI | 1548693526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARON MONIQUE SEYMORE Ubo 210-916-8563 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center Military/U.S. Coast Guard Outpatient |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2025-06-30 |