| NPI | 1487745899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD C WILLIS C.E.O 706-321-3901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 030693) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-04-22 |