| NPI | 1760759617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MICHELLE MCCALLUM Sole Proprietor 731-445-9406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TN 13555) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2014-10-15 |