| NPI | 1831942127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEE E WIRTH Credentialing/Practice Director 667-328-9217 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2025-02-27 |