| NPI | 1073606778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA DAVID ROBERTS Administrator 731-641-8728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-10-08 |