| NPI | 1588385868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRITZ RICHARDSON Owner 754-900-0503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2024-06-12 |