| NPI | 1265854947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE NORTHCUTT Office Manager 865-919-2122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TN DS0000001422) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2014-01-14 |