| NPI | 1174387880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVETTA CONNER Physician 731-217-6313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2024-02-13 |