| NPI | 1467433722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA L. F. BLASINGAME President 256-772-8566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X (Licence: AL AL164) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| Enumeration Date | 2005-11-13 |
| Last Update Date | 2020-04-19 |