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COLUMBUS, GA
NPI1184174302
Entity TypeOrganization
Authorized ContactMANILYN GRAHAM
Owner
706-464-6805
Organization Subpart ?No
Primary Taxonomy251S00000X 
(Licence: GA  LPC008002)
Enumeration Date2016-10-12
Last Update Date2016-10-12
Business Address
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1628 BREEDS HILL LOOP
COLUMBUS, GA 31907-6737
Phone number: 706-464-6805
Mailing Address
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1628 BREEDS HILL LOOP
COLUMBUS, GA 31907-6737
Phone number: 706-464-6805