| NPI | 1962707398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL ULANI TWYNHAM Owner 931-237-2265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MN 39691) |
| Enumeration Date | 2011-01-15 |
| Last Update Date | 2015-06-01 |