| NPI | 1912196494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE TYSON Office Manager 229-244-1211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 092-193) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2014-09-04 |