| NPI | 1366809717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITNEY L PETWAY Owner/Nurse Practitioner 731-300-7410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: TN 15852) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2017-01-04 |