| NPI | 1417513177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SASHA LASHEA' BUSSELL Owner 423-489-5841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-05-17 |