| NPI | 1962557140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA PAULINE WILKINS Owner 334-444-4819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AL L197) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |