| NPI | 1255001525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA TESKE Licensure Enrollment Manager 205-263-2559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2022-10-26 |