| NPI | 1376870741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLEEN J GORMAN Member 256-845-0428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 14962) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2025-03-14 |