| NPI | 1568152098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA HARDISON Owner 270-543-7557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2023-06-29 |