| NPI | 1558814798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES DEAN CANNON Managing Director 866-551-6779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: VA 0101254631) |
| Enumeration Date | 2016-07-23 |
| Last Update Date | 2016-07-23 |