| NPI | 1407107824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH LILES Owner 706-508-3957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: GA MT005277) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2012-09-25 |