| NPI | 1215586797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALEY S ACHOR Director 501-590-7018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2019-09-08 |
| Last Update Date | 2019-10-16 |