NPI | 1851830806 |
---|---|
Entity Type | Organization |
Authorized Contact | BARBARA JEAN UTERMARK President 706-860-5884 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 8593) |
Enumeration Date | 2017-02-22 |
Last Update Date | 2017-02-22 |