| NPI | 1093855215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABITHA CHRISTINA SANTALIZ Lpn, Office Manager 706-596-0078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 47587) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |