| NPI | 1144659830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON MICHAEL CISSELL Owner 404-819-1432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: GA 140922) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2013-11-04 |