| NPI | 1952562696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BURT WALLER Executive Director 901-260-8551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2012-01-23 |