| NPI | 1427100106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN WILLIAM WILDE President CEO Md 706-208-0065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 33231) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2010-02-19 |