| NPI | 1760630628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY JOSEPH LEE VILLANUEVA Owner/President 901-590-0103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 39777) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-09 |