| NPI | 1659838647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA DEFRIECE Billing Manager/Credentialing 423-339-2320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-02-26 |