| NPI | 1073189775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA LEE Owner 678-871-6068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-06-02 |