| NPI | 1528735602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI TRICHEL WALLACE-BASKEN Owner 901-335-8541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2022-02-02 |