| NPI | 1902403264 |
|---|---|
| Doing Business As | PROFESSIONAL PARK DIAGNOSTICS PLLC, , RADIOLOGY |
| Entity Type | Organization |
| Authorized Contact | DEBRA T MATTINGLY Credentialing Manager 270-852-8931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0200X Clinic/Center, Radiology |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2020-10-15 |