| NPI | 1063096618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMMY LARSON Owner 770-851-3123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2021-05-12 |