| NPI | 1750146510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA WOLFENBARGER Provider Enrollment COO Rdinator 865-500-2011 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2024-02-20 |