| NPI | 1164976825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES IVY LEE Physician/Owner 256-715-8193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: AL 14864) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2016-08-11 |