| NPI | 1821392515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA CUNDIFF-ROY President 270-866-4357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2011-02-14 |