| NPI | 1962698696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN JOHNSON Owner 865-908-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN DO0000001152) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2010-01-15 |