| NPI | 1184951998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA B BEALLIS Owner 479-806-0647 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AR E-5626) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2021-10-05 |