| NPI | 1134120280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN RIDER Administrator 865-380-9070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TN 0000000107) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2020-08-22 |