| NPI | 1649061094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RILEY WENDLING Central Support Specialist 629-266-1080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2025-05-15 |