| NPI | 1104256437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENA L SOARES Owner/Member 770-633-6503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 007474) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2013-11-22 |