| NPI | 1366928087 |
|---|---|
| Former Legal Business Name | PRIMARY CARE SOUTH LLC |
| Entity Type | Organization |
| Authorized Contact | MALCOM MATTHEW INGRAM Owner 731-427-0470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2020-01-23 |