| NPI | 1134589054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH W. MORALES Owner 912-265-9006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 31480) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 52148) |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 67817) | |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 50358) | |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2017-03-21 |