| NPI | 1033917992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARD HALES Credendialing Coordinator 615-403-4546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-07-07 |