| NPI | 1275244329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN CROCKER Owner 931-216-9095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QR0400X Clinic/Center Rehabilitation |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2022-12-09 |