| NPI | 1336456771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK DOSS Member Manager 205-238-1345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AL 5765) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2010-09-07 |