| NPI | 1093822280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA RIPPEE Administrator 901-412-4516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MS 897162) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-07-21 |