| NPI | 1912766221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 833-759-8720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2025-01-27 |