| NPI | 1790889053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY ELAINE THORNTON Clinical Dietitian 334-272-4670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient (Licence: AL 80) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2020-08-22 |