| NPI | 1417577982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLEEN CARBERRY Manager 423-362-4142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2022-10-24 |