| NPI | 1194995696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN D BRYAN O PT Ometrist 251-929-3191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AL S-490-TA-140) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-04-03 |