| NPI | 1114411782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAHANN VAUGHN Provider Network Manager 470-448-2782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2018-06-18 |