| NPI | 1043667686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP BANNOR Owner 423-760-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2016-07-01 |