| NPI | 1578336384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSON R. KUROSKI-MAZZEI CEO & Chief Compliance Officer 980-859-2106 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2024-04-08 |