| NPI | 1649997669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA COFFMAN Owner 270-256-5911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |