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1104415801
NICHOLAS ERIC RAY
GERMANTOWN, TN
NPI
1104415801
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
261QD1600X Clinic/Center, Developmental Disabilities
(Licence: TN 200004323)
Enumeration Date
2021-01-16
Last Update Date
2021-01-16
Business Address
NICHOLAS ERIC RAY MAT
1507 POPLAR ESTATES PKWY
GERMANTOWN, TN 38138-1840
Phone number: 901-828-1146
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Mailing Address
NICHOLAS ERIC RAY MAT
1507 POPLAR ESTATES PKWY
GERMANTOWN, TN 38138-1840
Phone number: 901-828-1146
Copy
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