| NPI | 1780177618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP ANDREW WILLIFORD Physician Assistant, Co Owner 270-227-0828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-06-14 |