| NPI | 1588166250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL L SPENCER Business Office Manager 731-265-6025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2018-03-08 |