| NPI | 1659544369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA JESSIE Billing Supervisor 706-432-4858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2008-06-19 |