| NPI | 1518169812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RUSSELL WARREN President 731-664-0103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 0000011892) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |