| NPI | 1932715935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY WINSTON SMITH Owner 541-810-2332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2023-12-12 |