| NPI | 1164763751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ALBERT MATHEWSON Owner 865-531-9129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 10492) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2013-03-07 |