| NPI | 1831711258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNWICK NATHAN Owner 888-900-8082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2020-08-31 |