| NPI | 1962913350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABRINA REEVES Co Owner 251-300-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL PA1092) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2019-09-12 |