| NPI | 1952761694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON VAN NELMS President 706-310-5050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: GA OPT2905) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-02-23 |