| NPI | 1952526774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY PEEVYHOUSE President 731-660-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X (Licence: TN L438-126-6423) |
| Additional Taxonomies | 251C00000X (Licence: TN L438-106-3593) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |