| NPI | 1548030794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN MICHELLE GRUDE Ap RN 615-613-7361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |