| NPI | 1982419883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERON HENRY Owner/Founder 888-780-8226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-02-10 |