| NPI | 1861664898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODERICK VINCENT FRAZIER Owner 615-851-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TN DS005013) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-03-31 |