| NPI | 1629945027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANDA CAMILLE WICKFALL Executive Director 901-530-8160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-20 |