| NPI | 1669168340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIO BROASTER Agent 706-305-4318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 347C00000X Private Vehicle |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-04-25 |