| NPI | 1679763049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP BALE Owner And Physician 270-670-8777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2009-04-17 |