| NPI | 1528684404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA DAMON MAYBERRY Managing Member/Hcp 731-618-6177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |