| NPI | 1083155543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE HAO NGUYEN Incorporator 770-431-9578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: GA DN012312) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |