| NPI | 1871348441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY BALOGH Owner 501-602-8979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 208D00000X General Practice |
| 261Q00000X | |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2024-05-03 |