| NPI | 1588716955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN BUTLER Billing Supervisor 706-227-7250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2008-06-13 |