| NPI | 1730590324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY KEITH GOUGE Owner 865-414-9346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA1728) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2015-11-24 |