| NPI | 1235515206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA PULANCO SALCEDO Office Manager 931-906-8818 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TN MD28194) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2015-07-31 |