| NPI | 1295174589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLINE DIANE BOYD Pres/Managing Member 386-316-0482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |