| NPI | 1023317856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDOLPH MARTIN Clinical Director 334-614-0959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AL 2786) |
| Additional Taxonomies | 251S00000X (Licence: GA LPC005656) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2011-03-18 |