| NPI | 1144610775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAY L GRESHAM Director 706-993-5186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: GA 2457) |
| Additional Taxonomies | 251S00000X (Licence: SC 10117) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2015-02-04 |