| NPI | 1104384197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIE D LAWRENCE Corporate Operations Coordinator 912-920-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2019-06-11 |