| NPI | 1336806900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT E HICKEY Authorized Official/Owner 423-210-0695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2022-08-01 |