| NPI | 1093184376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH SMITH Owner 678-517-7775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NC 98395) |
| Additional Taxonomies | 251S00000X (Licence: NC 98395) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2015-09-17 |