| NPI | 1659447696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDIA WHITE Administrator 731-772-4199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD8895) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2010-07-09 |