| NPI | 1316496664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RUSSELL WALLACE Medical Doctor 901-272-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TN 015359) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |