| NPI | 1700936754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA B DENNISON Owner 270-651-9696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2009-10-14 |