| NPI | 1306155460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNY CARL JOHNSON President 256-265-7480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: AL 8023) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: AL 17567) |
| 2086S0129X Surgery Vascular Surgery (Licence: AL 28901) | |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2020-07-27 |