| NPI | 1114010741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK VICTOR FAIRHURST President/Owner 615-870-1404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN 36190) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-03-19 |