| NPI | 1437514270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEMPESTT O STANTON Owner/Supervisor 251-366-7366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: AL 101581) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: AL 101581) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-21 |