| NPI | 1710008628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA BRATCHER State Director 901-384-3645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TN L3(20)4m3-056-6214) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |