| NPI | 1073795746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC DANIEL WIDEN Director 770-578-1400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2007-12-04 |