| NPI | 1104251412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER JACKSON GARNER Dentist 205-798-6561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AL 5113) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2013-09-05 |