| NPI | 1912241100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER A. MASON Owner 870-382-4303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2020-04-01 |