| NPI | 1104196062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY DO CEO 678-328-0577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: TX M4580) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 07845) |
| 111N00000X Chiropractor (Licence: TX 11358) | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-16 |