| NPI | 1649694415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LANE Member 205-908-7662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NC 7770) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2014-02-13 |