| NPI | 1831873330 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-06-15 |