| NPI | 1083607204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA WELLS Practice Manager 270-444-9889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2019-07-15 |