| NPI | 1245315621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R. TERRY ELLIS Owner/Partner 931-552-4935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-08-22 |