| NPI | 1700678091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY NICHOLS CEO 267-597-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QD0000X Clinic/Center, Dental | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-08-04 |