| NPI | 1760749634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEAH MICHELLE SMITH Credentialing Manager 901-205-3999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY 22 634573) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2023-11-13 |