| NPI | 1346474970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRTLE TOLIVER Provider Affairs COO Rdinator 901-461-5368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2009-09-03 |