| NPI | 1497892103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L WILSON President 270-442-8575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2019-10-21 |