| NPI | 1396367850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY ANDERSON Administrator 334-676-3773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2020-05-07 |