| NPI | 1558772806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA LASHON PERRY Administrator 901-737-3990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 0247) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2014-05-08 |