| NPI | 1194208389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MCEARL Business Office 731-891-0708 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2018-09-13 |