| NPI | 1679751341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRIMA R FOSTER Provider/Owner 706-478-5858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care (Licence: GA 57619) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2015-07-29 |