| NPI | 1881324531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER MARK VANRAAM COO 205-703-6760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2024-03-07 |