| NPI | 1760790414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN KEITH BONNER President 706-249-1680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0003X Pharmacy, Managed Care Organization Pharmacy (Licence: GA 017193) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2010-09-15 |