| NPI | 1578151551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ELINE Billing Manager 877-504-7362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2022-10-06 |