| NPI | 1073057857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA D TETREAULT Practice Administrator 931-503-9007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 30526) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2016-12-13 |