| NPI | 1871326629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA MARSH CEO 267-319-2780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2024-08-26 |