| NPI | 1063512945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE CLEGHORN Business Administrator 229-382-9338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: GA 111094ASCA) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2019-07-16 |