| NPI | 1760736565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA PROCTOR Billing Administrator 501-603-0003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR C4604) |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2012-10-31 |