| NPI | 1790701654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIA LYNN PUCKETT Office Manager 731-644-3211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 2086S0129X | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-11-05 |