| NPI | 1518140524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERON GERARD HARRISON CEO/Owner 478-453-3532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 051143) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |