| NPI | 1982362299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA HARLAN Director Credentialing & Enrollment 615-948-9639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2024-11-07 |