| NPI | 1083854731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT L. KUPPER Owner 270-422-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2022-06-14 |