| NPI | 1417057902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY R. LONG President 270-746-5455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2008-03-06 |