| NPI | 1679371058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHACOYA GHRAHAM Owner 980-297-8237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-03-03 |
| Last Update Date | 2025-05-27 |