| NPI | 1144481458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY Q PHUNG Owner 770-719-2221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA CHIR008288) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2008-06-19 |