| NPI | 1376537654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY JOE MANION Owner CEO 270-651-7796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2019-02-14 |