| NPI | 1912992587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WILLIAM RETTERBUSH Owner President 229-244-0034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 20145) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 51883) |
| 208600000X Surgery (Licence: KY 19642) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2008-06-19 |