| NPI | 1609317692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGARY COLEMAN BYERS Owner/Provider 731-212-3196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: TN 18850) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2025-03-25 |