| NPI | 1669074159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY BROWN Chief Executive Officer 833-262-1101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 251S00000X Community/Behavioral Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2022-12-20 |