| NPI | 1942668686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER DEVON BRADLEY Nurse Practitioner 870-413-9890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: GA F1015056) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-09 |