| NPI | 1124497730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL D RADICAN President 901-682-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2025-07-25 |