| NPI | 1649349374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE HORNER Off Mgr 731-286-4302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: TN DO839) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |