| NPI | 1164868592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TWANNA REAVES Owner 731-609-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: TN 07519597) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2015-11-05 |