| NPI | 1578797627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAO TULASI IMMANENI CEO 912-247-0409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 044756) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA APPLIED FOR) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2009-05-07 |