| NPI | 1700106549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIROLYN RUTH MOFFETT President 870-204-5129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AR E0693) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2010-06-03 |