| NPI | 1124325865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MCNULTY Part Owner 270-570-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2020-08-07 |