| NPI | 1043967581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA MARIE MOUNCE Nurse Practitioner 479-200-9295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2022-03-04 |