| NPI | 1982580619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELECIA K OSBORNE Co Owner/Financial Officer 731-618-0398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |