| NPI | 1497964118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS O PAUL Owner 205-620-4867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AL 304711) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: AL 304711) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2008-02-08 |