| NPI | 1508907684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ALBERT Owner 256-810-3036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 15691) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-063128) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2013-01-07 |