| NPI | 1871905794 |
|---|---|
| Other Name | (MARYVILLE) |
| Entity Type | Organization |
| Authorized Contact | HOLLY C ELKINS Owner 931-319-9053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN PA0000001336) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |