| NPI | 1790257673 |
|---|---|
| Doing Business As | BAXTER REGIONAL VITALITY CLINIC |
| Entity Type | Organization |
| Authorized Contact | DEBRA HENRY CFO 870-508-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2018-12-17 |