An Integrative Medicine discussion featuring experts in diagnosing and treating Traumatic Brain Injury. The Brain Injury Summit is held June 1, 2019 in Scottsdale Arizona at Holistic Urgent Care. Our goal is to share the latest updates in diagnostic testing for traumatic brain injury and effective management of TBI patients to maximize healing and restore function. visit www.holisticurgentcare.com to learn more. Or follow us on Facebook or Instagram!
1. Brain Injury Summit
Saturday June 1st 2019
www.holisticurgentcare.com
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
1
2. Today’s Agenda
• Clinical Assessment and Diagnosis of
Concussion/TBI
• Dr. Rebecca Miller – Naturopathic Physician and
founder of Holistic Urgent Care
• Dr. Gary Rosas – E.R. Physician
• Dr. Raul Galvez – Pediatric Radiology
• John Leonard – former NCAA quarterback, BrainScope
Market Development Manager
• TBI Recovery – Therapeutic Modalities and
Lifestyle Medicine to promote healing from TBI
• Dr. Rebecca Miller
• Dr. Simon Billingham – Functional Neurology and
Electrons Plus Guided PEMF
• Dr. Diana Mladenoff – Chiropractor, Neurofeedback
Expert, and Concussion Clinic Medical Director
• Joanne Phillips M.S. R.D. – Empowered through TBI,
Nutrition Expert and TBI Survivor
• Marian Mitchell – Integrative Medicine Health Coach
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
2
3. Learning Objectives
• Clinical Assessment and Accurate
Diagnosis of TBI/Concussion
• Identify Common Signs and Symptoms
• SCAT 5 Diagnostic Tool; ACE Form
• Criteria for CT Scan and/or ER Visit
• Applications for BrainScope
• Second Impact Syndrome/Return to Play
• Effective Treatments for TBI Recovery
• Nutrition Strategies for Brain Health
• Vitamins and Supplements that benefit
TBI Patients
• OTC and RX Pharmaceuticals for TBI
• Hormone Therapy in TBI Patients
• Clinical Modalities for Rehab of TBI
• PEMF, Neurofeedback, HBOT
• IV Therapy – Ozone, HDIVC, NAD
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
3
4. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
WTF is a Holistic Urgent Care?
4
5. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
What is Naturopathic Medicine? AKA - are you a “real” doctor? 5
6. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
6
7. The Pickle Pledge
I will turn every complaint into a constructive suggestion
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 7
8. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
8
9. I hit my head –
now what?
Clinical Assessment and Diagnosis
of mTBI/Concussion
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
9
10. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
#metoo
10
11. Dr. Gary Rosas M.D. MBA
www.thebalancedlifemd.com
Emergency Room Physician
Human Potential Coach
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
3
12. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Before we get going, let’s introduce some key terminology
12
13. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
13
14. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
14
15. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
15
16. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
16
17. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
17
18. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
18
19. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
19
20. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 20
21. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
21
22. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
22
23. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
23
24. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Its all about C.Y.A. No one gets sued for doing “too much”
24
25. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
14% of ER Visits for Head Injury.
70% of CT Scans run in the ER were of the Head.
25
26. Dr. Raul Galvez-Trevino M.D.
Pediatric Radiology
Considerations for Neuroimaging of TBI
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
26
27. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
So what’s the big deal about CT Scans anyways?
27
28. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Medical Imaging and Cancer Risk
28
29. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Diagnosis in Babies/Toddlers is especially difficult.
Radiation Exposure at this age is especially dangerous.
29
30. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Head Trauma CT Scan Criteria Ages 2-13
30
31. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Intracranial Hematoma or Hemorrhage
A.K.A. “Brain Bleed”
Often Asymptomatic at first
Without prompt diagnosis & treatment, Often fatal
31
32. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
32
33. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
33
34. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
What happens in Vegas….. …was brought to AZ! 🌵
34
35. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
35
36. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
36
37. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
37
38. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
38
39. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
39
41. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
41
42. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
42
43. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
How can we prevent
Second Impact Syndrome?
When is it appropriate to return to play?
43
44. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
44
45. Healing from a
Traumatic Brain Injury
Lifestyle Medicine
Therapeutic Modalities
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 45
46. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
46
47. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
47
48. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
48
49. Therapeutic Tools for Healing TBI’s
• Interventional Therapies
• Dr. Diana Mladenoff
• Concussion/TBI Expert
• Neurofeedback
• Dr. Simon Billingham
• Functional Neurology Expert
• Founder Electrons Plus PEMF
• Dr. Rebecca Miller
• RX and OTC Therapies for TBI
• Procedures, Infusions, and Holistic Treatments for TBI
• Individual Practices/Lifestyle Medicine
• Joanne Phillips
• TBI Survivor, founder “Empowered Through TBI”
• Masters in Nutrition Science; Designs for Health
• Dr. Rebecca Miller
• The 3 Non-Negotiables
• Environmental Exposures and Clinical Variables to
consider with TBI patients
• Marian Mitchell
• Integrative Medicine Coach
• How to feed a Brain
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
49
50. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
50
51. TBI’s Cause Oxidative Stress
Making you MORE SENSITIVE to other stressors!
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
51
52. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
52
53. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
53
86. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
86
87. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 7
88. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
88
89. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 2
90. What a Healthy
Diet Looks Like
for TBI Recovery
Marian Mitchell
Integrative Health Coach
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
90
91. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
4
92. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
5
93. Environmental
Exposures and TBI
These every day threats become MAGNIFIED when your
Brain is Injured.
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 93
94. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
94
95. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
95
96. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
96
97. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
97
98. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 2
99. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
99
100. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
100
An injured brain loses it’s ability to regulate – easily overstimulated and emotionally labile
101. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
101
102. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
102
103. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
103
104. Vitamins and Minerals
Nutritional Supplements to consider
for TBI Recovery
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 104
106. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
106
107. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
107
108. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
108
109. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
109
110. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
110
111. Nutrient
Density in
Food
Why would I need to take
vitamins?
How could I be so deficient?
But I eat so “HEALTHY”!
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 112
112. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
112
113. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
113
114. Joanne Phillips, MS, RD
Nutrition Expert and TBI Survivor
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
4
115. Joanne Phillips M.S. R.D.
• TBI Survivor
• Expert in TBI Recovery
• Brain Injury Nutrients/Supplements
• Cranial Osteopathy
• PRP and Stem Cells
• HBOT
• Empowered Through TBI – est. 2019
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
115
116. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
3
117. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
2
The Day EVERYTHING Changed – April 15, 2007
118.
119.
120. Nutrients for
the Brain
• DHA (Omega 3’s)
• Phosphatidylserine (PS)
• Aceytl-L-Carnitine
• Glycerophosphocholoine
• Ginko Biloba
• Vinpocetine
• Magnesium Threonate
• CoQ10/PQQ
• Exogenous Ketones
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
4
121. DHA
• Fish oils
• Helps release neurotransmitters more efficiently and effectively across
the synapse resulting in better communication
• Increases BDNFs (Brain Derived Neurotropic Factors)
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
8
122. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
4
123. Phosphatidylserine
(PS)
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 123
Phospholipid
component of brain
cell membranes
Need to maintain
cell membrane
fluidity along with
FA (DHA)
Plays a vital role in
cell to cell signaling
in the brain
Helps in memory (working and long term),
logic, concentration, recall, clarity of thought,
initiative, attention span
124. Glycerophosphocholine (Alpha-GPC)
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
4
NATURAL COMPOUND FOUND
IN OUR CELLS
HELPS IN THE SYNTHESIS OF
PHOSPHOLIPIDS
BOOSTS ACETYLCHOLINE LEVELS
WHICH HELP WITH MEMORY, MENTAL
FOCUS AND REACTION TIME
125. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 125
126. Acetyl-L-
Carnitine
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
126
Naturally found in the brain, CNS, spinal cord, motor
nerves and skeletal muscle
Form of L-Carnitine that helps energize the brain
Plays an important role in the transfer and utilization
of long chain fatty acids to produce energy
Helps support acetylcholine production which
needed for memory, focus and learning
Antioxidant
127. Ginko Biloba
• Promotes good blood circulation in the brain
• Protects the brain from neuronal damage
• Antioxidant
• Helps with cognitive function
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
127
128. Vinpocetine
• Vasodilator
• Relaxes the vascular smooth muscle
• Enhances cerebral blood flow
• Protects neurons
• Improves memory, focus and learning
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
128
129. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
3
130. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
2
131. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 127
132. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
132
133. 8
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Exogenous Ketones and TBI
134. Brain Derived
Neurotropic
Factors
(BDNFs)
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
134
Miracle grow for the brain
Stimulates the growth of new neurons:
neurogenesis
Higher BDNFs make the brain more resistant to
decline
Increases the size of the hippocampus
Enhances long term memory
Lower BDNFs have been associate with
depression and dementia
135. Proven to Increase BDNF
• Exercise
• Sunlight
• Sleep
• Socializing
• Fasting/Caloric Restriction
• Meditation
• Yoga
• Coffee Fruit Extract
• Curcumin
• Omega 3’s
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
135
136. Treatments
that helped me
HEAL my TBI
• Craniosacral Osteopathy
• Intranasal Stem Cells
• PRP
• HBOT
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
5
137. Craniosacral Osteopathy
• Cranial osteopathy (also called cranial therapy or craniosacral therapy)
is one variety of osteopathic manipulative therapies.
• It stimulates healing by using gentle hand pressure to manipulate the
skeleton and connective tissues, especially the skull and sacrum
• Frees up restrictions in the movement of cranial bones and associated
soft tissues and to stimulate the flow of the cerebrospinal fluid, which
bathes all the surfaces of the brain and the spinal cord
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
137
138. Intranasal Stem Cells
• Pluripotent stem cells from the blood
• These are uncommitted cells that can generate into neural cells
• Goal of stem cell treatment is to replace damaged cells and to promote
the growth of new blood vessels and tissues to help the target organ
function at a greater capacity.
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
138
139. PRP (Platelet Rich Plasma)
• 300 different growth factors
• These can help rebuild collagen in the brain
• Pluripotent cells work in combination with PRP to help the stem cells
migrate to the damaged tissue
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
139
140. HBOT – Hyperbaric Oxygen Therapy
• Hyperbaric oxygen therapy (HBOT) is a medical treatment which
enhances the body's natural healing process by inhalation of 100%
oxygen in a total body chamber
• The HBOT was used post stem cell treatments as it upregulates stem cell
activity by 400-500%.
• The use of HBOT increases oxidation, increases blood flow, increases
angiogenesis and increases collagen production.
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
140
141. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
141
142. Dedicated to
empowering the
survivors of Traumatic
Brain Injury and their
caregivers with
cutting-edge
information and
resources
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
142
144. Tools for TBI RECOVERY in
offered in our Practice
•Nutritional Supplements
•IV Therapy
•Glutathione
•NAD Therapy
•Ozone Therapy
•Infrared Sauna
•Acupuncture & Cupping
•PEMF – Electrons Plus Guided PEMF
•Neurofeedback
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
8
145. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
145
146. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
146
147. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary CareDr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
147
148. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
148
149. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
149
150. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
150
151. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
151
152. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
152
153. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
153
154. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
154
157. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
157
158. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Ozone Therapy
158
159. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
159
160. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
160
161. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
161
162. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
162
163. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
163
164. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
164
165. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
165
166. Dr. Simon Billingham
• Chiropractor
• Functional Neurology
• Founder of Electrons Plus Guided PEMF
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
143
167. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
167
168. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
168
175. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Current Recommendations for
Outpatient Drug Treatment of
Post Concussive Symptoms
• Antiemetics
• OTC Analgesics
• Acetaminophen most commonly
recommended
• Amantadine (potentiates
dopamine)
• SSRI’s (anti-depressants)
175
176. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
176
177. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
177
178. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
178
179. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
179
180. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
180
181. SMART DRUGS
Neuropharmacology of enhancing Memory and Cognitive
Function
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
9
182. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 4
183. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
2
184. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
2
185. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
3
186. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
5
187. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
6
188. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
188
189. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 189
190. Hormone Therapy and TBI Recovery
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
190
191. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
191
192. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
192
NED = Neuroendocrine Disorder
193. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
Sufficient Thyroid Hormone is
Necessary for Brain Injury Healing.
193
194. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
8
195. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
195
196. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
196
197. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
9
198. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
198
199. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care 2
Testosterone and TBI
200. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
200
201. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
201
202. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
202
203. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
203
TBI Shrinks the size of your “Bucket”
204. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
204
205. v
• Minimum 150 Minutes per week
of Moderate Exercise
• Or 75min/wk Vigorous Exercise
• Strength Train 2X per week
• At least 20min per day gentle
activity for TBI recovery
Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
205
206. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
206
207. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
207
208. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
208
209. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
209
210. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
210
211. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
211
212. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
212
213. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
213
214. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
214
215. Dr. Rebecca R. Miller - Holistic Urgent Care + Primary Care
215