| NPI | 1508916206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDIA WHITE Administrator 731-660-6828 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: TN MD8895) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2010-07-09 |