| NPI | 1386008753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELIZABETH STATUM Owner/Member 901-550-7867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TN LPC0000002198) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-04-11 |