| NPI | 1760688477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK E, TIDSWORTH Consulting Director 1803-673-3634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: SC 2130) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-08-22 |