| NPI | 1649896804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN LEIGH LAURELLA Am 321-802-4521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-10-10 |