NPI | 1780964841 |
---|---|
Entity Type | Organization |
Authorized Contact | CLIPHANE W MCLEOD Owner 912-373-7035 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA GA029212) |
Enumeration Date | 2011-08-22 |
Last Update Date | 2011-08-22 |