| NPI | 1104204379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE WILKES Owner/Medical Director 770-572-7574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA RN162951) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |