| NPI | 1700354453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE LUSTER Owner 901-626-2129 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2018-11-09 |