NPI | 1003150160 |
---|---|
Entity Type | Organization |
Authorized Contact | WILLIAM HARRELL WARD President 251-981-2420 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AL 20122108) |
Enumeration Date | 2012-11-15 |
Last Update Date | 2012-11-15 |