| NPI | 1609309855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY MICHELLE O'CONNOR-WRAY Fnp, Owner 731-265-6197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TN 000896897) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-07-21 |