| NPI | 1154586667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY H TAFT Owner 678-371-6463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: GA MT000400) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2009-09-27 |