| NPI | 1568847879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON W ROGERS President 888-985-6640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 208D00000X General Practice | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2016-03-16 |