| NPI | 1093833196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA B HYDER Practice Office Administrator 423-638-4131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: TN 13954) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: TN 23745) |
| 261QP2300X Clinic/Center Primary Care (Licence: TN 23071) | |
| 261QP2300X Clinic/Center Primary Care (Licence: TN 26381) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-24 |