| NPI | 1861667891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT A MCLEISH Owner 229-226-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: GA 047235) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2008-04-30 |