| NPI | 1730555780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELENE HAIRSTON STEPHENSON Owner 276-421-2156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-08-13 |