| NPI | 1871249193 |
|---|---|
| Doing Business As | DIVERGENT PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | TETSOMA TONWE Owner 302-734-2444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 251S00000X |
| 332900000X Non-Pharmacy Dispensing Site | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-02-24 |