| NPI | 1902964570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY G MILLER Billing Manager 334-613-7076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: AL 26765) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-05-02 |