| NPI | 1457134595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARI WIDDIFIELD Practice Administrator 423-339-9581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-12-04 |