| NPI | 1861099723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANTLEY TILMAN JOLLY President, Secretary, And Treasurer 888-362-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2023-02-16 |