| NPI | 1619031986 |
|---|---|
| Other Name | DO CO - 11TH AVE |
| Entity Type | Organization |
| Authorized Contact | DANA P GLASS Cheif Executive Officer 229-430-4005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2025-12-30 |