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 |