| NPI | 1235502204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY DIANNE CASSRIEL President 901-857-1150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: TN 210506056) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: TN 115004107) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |