| NPI | 1659860807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE A JESSEE Business Manager 270-670-3520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2018-05-03 |