| NPI | 1013460286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA AULTMAN Managed Care COO Rdinator 770-822-4203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |