| NPI | 1396749917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA REEDER Executive Director 270-444-8183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207RI0200X Internal Medicine Infectious Disease |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2024-07-27 |