| NPI | 1811486905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRAN BOLDEN Credentialing Consultant 256-325-0896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 51987) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |