| NPI | 1003327412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATISHA EDMONDS Office Administrator 270-265-2574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2018-06-15 |