| NPI | 1629741210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN COSIMI CEO 386-236-1811 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208D00000X General Practice |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2025-03-06 |