| NPI | 1699919399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA SUSAN PHILIPOSE Nurse Practitioner/Owner 1502-417-4956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: TN 13535) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: TN 13535) |
| 261QU0200X Clinic/Center, Urgent Care (Licence: TN 13535) | |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2009-11-12 |