| NPI | 1780929984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK MICHAEL STOOKSBERRY President 731-587-9670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN 8602) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2012-11-29 |