| NPI | 1679775308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY HUMPHREY Program COO Rdinator 877-267-3728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: MI 4301037778) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |