Organization
PETRE-JO LLC
Active
Parent organization
PETRE-JO LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PETRE-JO LLC
Authorized official
PETER KONECNY (MANAGING MEMBER)
(931) 761-0410
Entity
Organization
Contact information
Practice address
607 W DUE WEST AVE STE 95, MADISON, TN 37115-4415
(615) 982-8081
Mailing address
858 HARBOUR GREENS PL, SPARTA, TN 38583-4294
(931) 761-0410
(855) 210-7700
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
L000000017166
TN
Other
Enumeration date
04/06/2016
Last updated
04/06/2016
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