| NPI | 1598750762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HUEY RANDOLPH KIDD Owner/Manager 334-636-5311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2022-07-21 |