| NPI | 1720204308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN PENIX President 706-828-6868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: SC 2288) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |