| NPI | 1023383163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDIE P PETRY Owner 256-891-3733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AL 1566) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |