| NPI | 1881699106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY DAWN WILKINS Credentialing Facilitator 931-461-5056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: TN 124) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2020-08-22 |