| NPI | 1215229455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE L. SHACKELFORD Member 251-639-7101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: AL S-421-TA-151) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2011-06-22 |