| NPI | 1386951101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN LYNN FREDERICK Owner 731-279-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TN 14836) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |