| NPI | 1760711287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME RERUCHA Owner/President 706-485-9917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA CHIR007549) |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2009-12-11 |