| NPI | 1043617657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN RAE EGAN Sole Member 423-505-3750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN 9373) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2014-11-25 |