| NPI | 1104236421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER JS GODDARD Owner 865-321-1732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN DO0000002081) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2016-10-25 |