| NPI | 1710559463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY LYNN DIXON Office Manager 270-465-1535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2021-07-13 |