| NPI | 1174961239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER L FORE Owner 870-283-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |