| NPI | 1932796240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDRA FICKEN Sr. Manager Of Rcm 855-408-1143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2026-01-23 |