| NPI | 1568206381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA STREETER Chief Administrative Officer 800-699-9395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2024-06-25 |