| NPI | 1881461846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA TASHA NICHOLE KRAUTH Director 346-473-5945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2024-06-01 |