| NPI | 1619113867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE DANIEL LOGAN Managing Member 423-775-4261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TN DO 1846) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2019-06-25 |