| NPI | 1942233549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA I BENNETT Office Manager 731-664-7949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 21758) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: TN 21758) |
| 261QP2300X Clinic/Center Primary Care (Licence: TN 21758) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2012-06-21 |