| NPI | 1962293084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN PARDEN Owner/AO 334-659-4717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-05-16 |