| NPI | 1295461663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI TYE Billing And Credentialing 606-215-3832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2023-10-11 |