| NPI | 1982129706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MCCLINTOCK Compliance Officer 866-374-6628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2022-06-06 |