| NPI | 1902392699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMERA NICOLE THOENER Owner/Provider 629-888-3256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 20632) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2024-04-30 |