| NPI | 1023425881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE KWAME BROOKS Program Director 777-833-7739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 040580) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2014-07-14 |