| NPI | 1942554068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE R BURCHETT Member 606-886-8466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2015-05-05 |