| NPI | 1932969334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY ELIZABETH BELLINGER COO 140-490-2082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-05-10 |