Individual
TARA BRUNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1560 CEDAR FARMS CV, CORDOVA, TN 38016-6143
(901) 287-0704
Mailing address
1560 CEDAR FARMS CV, CORDOVA, TN 38016-6143
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
080511698
TN
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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