| NPI | 1578120440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLIE WOODSTOCK Director Of Accounting & H/R 800-460-2152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2019-05-24 |