| NPI | 1114237922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LAGESSE Sr VP Physician Group Inc 229-312-1000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2010-10-14 |