| NPI | 1427418862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MABEL KEYENASOA EKUNDAYO Director 615-887-0309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 645163) |
| Enumeration Date | 2016-02-27 |
| Last Update Date | 2016-02-27 |