| NPI | 1750651832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE A WALKER Owner 731-616-6881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 35452) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 36105) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2013-02-11 |