| NPI | 1992724124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY A JOHANSEN President 205-421-2102 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-03-27 |