| NPI | 1841566627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY WILLIAM COTTER Vice President/Secretary 251-414-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-03-27 |