| NPI | 1104558006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DANHAUER Owner 270-684-2341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2022-09-01 |