Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Multi-Specialty |
261QM1300X | 70 | Clinic or Group Practice |
| NPI # | 1598903874 |
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| LBN Legal business name | LIFE CENTER CLINIC | ||||
| Authorized official | SHEILA TOON - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 01/26/2009 | ||||
| Last updated | 01/26/2009 - About 17 years ago | ||||
| Identifiers |
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