| NPI | 1649019704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 855-380-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-08-06 |