| NPI | 1750997706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDRA E MOORE Member 256-777-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2023-11-08 |