| NPI | 1336375930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISSY SALLAS Administrator 334-293-3920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AL PENDING) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2022-02-14 |