| NPI | 1154895670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAPHNE T FOUST Physician Assistant/Owner 731-540-7075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-01-17 |