| NPI | 1396137402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD ROLLOW Secretary Treasurer 205-558-7401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AL Medicaid RCO) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2015-02-26 |