| NPI | 1700172392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE LONNETTE DODGE Administrator / Owner 931-952-3499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TN I000000017110) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2015-10-23 |