| NPI | 1730321126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYLVIA RENEE WOODS Owner 251-633-2524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AL 086204) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2009-04-01 |