| NPI | 1972804110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN R WICKMAN Owner 901-377-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TN 22064) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: TN 12858) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-04 |