| NPI | 1548753866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE E VINCENT Owner 385-262-4135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 281795-4405) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2024-01-19 |