| NPI | 1811304439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA SUE PETTY Office Manager 901-751-0939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 111NR0400X |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2020-02-25 |