| NPI | 1659808426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE COLEMAN General Manager 731-861-0994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2018-07-12 |