| NPI | 1760772917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BURT WALLER Executive Director 901-260-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TN N/A) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2011-04-11 |