| NPI | 1922424886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ATHENA TOLIVER Adminstor 386-846-1793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: GA 066307) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-03-14 |