| NPI | 1841513058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BURT WALLER CEO 901-260-8551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2012-01-20 |