| NPI | 1093838880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON FAULK CEO 334-567-4311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AL 00011939) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |