| NPI | 1306142161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY JOSEPH FAVA Owner 256-832-4051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AL AL14852) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2011-01-26 |