| NPI | 1225197031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA DIANE WEAVER Practice Manager 270-554-3904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2020-08-22 |