| NPI | 1104141837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER MORALES Owner 678-807-2241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 055771) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2010-04-06 |