| NPI | 1972919496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE SKOURTES Owner/CEO 855-433-6825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OR H6653) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2014-07-03 |