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 |