| NPI | 1972150084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACHELLE GRIFFIN Chief Human Resource Officer 769-208-4437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2025-08-04 |