| NPI | 1679340707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABRINA JILL SPAHR Provider Enrollment COO Rdinator 865-500-2143 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2023-12-08 |