| NPI | 1104193366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES HARTWELL SHANKS Owner 865-977-8048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN DS7825) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2012-02-10 |