First Name    Last Name   
Contract Details
Facility name
Provider ID
11111111111111
Tax ID
36396675
Effective Date
2/1/2020
Last Updated
2/13/2020
Direct Contract
No
Status
Active
Contract Discounts
Location Details
Address
1930 Edwards Lake Rd Suite 110
Birmingham, AL 35235-3719
United States
Phone
877-448-3627 (Phone)
Billing Details
Address
Birmingham, AL
Specialty Type
Ambulatory Surgical Facility