| NPI | 1235295627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE R STIERWALT Owner Md 256-845-1311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AL 00013506) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |