| NPI | 1689401465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH ALLEN BLACKMON Physician/Medical Director/Owner 270-444-8477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2025-05-09 |