| NPI | 1043717580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTHANNE WILKES Owner 334-792-6736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-074982) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-04-11 |