| NPI | 1104365386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD CASEY Owner 270-769-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2018-04-24 |