| NPI | 1689336695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOUNJEA LEE Np 347-834-1117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2021-10-13 |