Brent  A  Tidwell    DC
Contract Details
AA Pre-Employment Center
Facility name
Provider ID
P000001746
NPI
1154438802
Tax ID
631203949
Effective Date
3/1/1999
Last Updated
3/4/2022
Direct Contract
Yes
Term Date
2/28/2022
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_067
Location Details
Address
819 Mimosa Park Road Suite A
Tuscaloosa, AL 35405
United States
County
Tuscaloosa
Phone
2057527503 (Phone)
Billing Details
Address
819 Mimosa Park Road
Suite A
Tuscaloosa, AL 35405
Billing Phone
2057527503
Specialty Type
Chiropractic Medicine
Map
Address