| NPI | 1578001202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE KNOX Clinical Practice Manager 844-329-9822 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2017-03-30 |