| NPI | 1801477369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BREANNA LUSTRE Owner 615-882-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2021-10-01 |