| NPI | 1639357312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY M JOHNSON Practice Manager 870-307-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR MC2605) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2014-03-11 |