| NPI | 1538225529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORBI D MILLIGAN Owner 615-223-5656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN MD0000038938) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2023-03-07 |