| NPI | 1215292552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE LARAYA Owner Member 901-218-5328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TN MD29040) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-07-12 |