| NPI | 1730407560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY J KELLY Insurance COO Rdinator 931-525-6059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: TN D57545) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2018-06-20 |