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 |