NPI | 1821318643 |
---|---|
Entity Type | Organization |
Authorized Contact | WALLACE LARAY VINSON Registered Surgical Assistant 931-215-1574 |
Organization Subpart ? | No |
Primary Taxonomy | 171W00000X Contractor (Licence: IL 238000232) |
Additional Taxonomies | 171W00000X Contractor (Licence: IL 238000042) |
Enumeration Date | 2010-06-03 |
Last Update Date | 2010-06-03 |