| NPI | 1124237482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARRIO THOMAS Provider 901-537-0077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN 0000007671) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |