| NPI | 1104173798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE E WALKER Office Manager 770-945-2119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: GA DN010592) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2012-08-14 |