| NPI | 1720761059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKIE WEDLOCK Biller 564-654-0537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-08-11 |