| NPI | 1225481252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY SCOTT LEE Owner/Manager 931-879-9544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN 10104) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2016-07-14 |