| NPI | 1548221781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL E RUDD Administrator 731-422-0330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TN 0000000030) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-08-22 |