| NPI | 1871039883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH RUGGIERO WALLIS Therapist 501-400-6570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AR PO807061) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: AR MO704002) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2019-06-24 |