| NPI | 1942572672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEDIDIAH MONSON Owner 615-252-7212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA A69490) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2022-05-10 |