| NPI | 1720314156 |
|---|---|
| Former Legal Business Name | CHICKEN GEORGE |
| Entity Type | Organization |
| Authorized Contact | MONROE AUSTIN CAO 334-727-4306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2009-10-20 |