| NPI | 1740967520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE P BARNES-WOODS Owner 769-567-1527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-06-03 |