| NPI | 1518425941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL L SPENCER VP Of Operations 731-608-0933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2019-03-05 |