| NPI | 1043459878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREZALIA L. OLIVER Clinical Director 478-451-3112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA CSW00658) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-02-18 |