| NPI | 1891853743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEJUANA L. RIAT Physician Assistant 134-737-5272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1102X Clinic/Center, Military Outpatient Operational (Transportable) Component |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |