| NPI | 1598063828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD D SHEPPARD Supervising Physician 276-679-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2011-03-10 |