NPI | 1841739984 |
---|---|
Entity Type | Organization |
Authorized Contact | LATRELL JENKINS Owner 912-978-8282 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 047470140) |
Enumeration Date | 2017-02-22 |
Last Update Date | 2017-02-22 |