| NPI | 1750813572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA L WILLIAMS Owner 256-503-3888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AL 3802) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: AL C2667A) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-08-31 |