| NPI | 1003343864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA LYNN FITZGERALD Administrative Manager 870-333-5488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN E-2900) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |