| NPI | 1366841066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY POUNDERS WEAVER Medical Supervisor 901-262-0185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS R629189) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2014-12-01 |