| NPI | 1730076761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON T PETERSON Owner 276-638-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-06-23 |