| NPI | 1316121429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY PARKS Practice Administrator 229-242-3002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2015-05-05 |