| NPI | 1669106118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA TESKE Licensure Enrollment Manager 205-641-3423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-07-11 |