| NPI | 1174864946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA WILSON Credentialing Specialist 901-252-3411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2013-03-04 |