| NPI | 1578308862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSI SULLIVAN VP Clinical Services 888-760-4266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-06-28 |