| NPI | 1750918157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN DONER Owner 888-316-9085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| 261Q00000X | |
| 261QG0250X | |
| 261QH0100X Clinic/Center, Health Services | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2020-06-03 |