| NPI | 1922517846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WOO Director Of Operations 628-228-2707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2018-12-18 |