| NPI | 1568152643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT M ROTH Mgr/Member 877-465-4384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-05-11 |