| NPI | 1295273993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE WILLIS Owner/Partner 731-249-9777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |