| NPI | 1851707418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS JOHN LOSITO Clinical Director 877-867-8556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 286500000X Military Hospital |
| 282J00000X Religious Nonmedical Health Care Institution | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2014-07-03 |