| NPI | 1790873834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE T HAYGOOD Owner 906-360-2109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX L7749) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-02-17 |