| NPI | 1063876076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER KONECNY Managing Member 931-761-0410 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN l000000017166) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |