| NPI | 1518034354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE CATHLEEN JUDY Director, Credentialing 901-737-4665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0800X (Licence: OH 143 Facility# 0084AS) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-02-13 |