| NPI | 1821549536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CARTER Credentialing Specialist 541-600-7018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: SD CP001133) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |