| NPI | 1184621120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK B ELLIS Physician 334-347-4343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AL DO463) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2018-03-27 |