| NPI | 1215158951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DEBRINCAT Owner 770-894-4950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 13702) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2008-07-30 |