| NPI | 1952425019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL E BANACH Owner 334-361-3090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 23409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 16083) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |