| NPI | 1710516901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTIE Y DOUGLAS Credentialing Specialist 615-514-6876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-04-08 |