| NPI | 1922392364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA EDWARD LANE Provider/President 706-322-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2023-03-15 |