Organization
THCP BHAM AL 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES BURBAGE (OWNER)
(949) 525-1069
Entity
Organization
Contact information
Practice address
3829 LORNA RD, SUITE 312, HOOVER, AL 35244-7034
(949) 525-1069
Mailing address
3829 LORNA RD, SUITE 312, HOOVER, AL 35244-7034
(949) 525-1069
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/28/2015
Last updated
05/24/2017
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