| NPI | 1760414056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES C LODEN Owner/Medical Director 731-642-5003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TN TN23) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TN 0000000023) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-02-17 |