| NPI | 1508116948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES MARCUS CEASAR Owner 762-241-3710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 110364) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-10-02 |