| NPI | 1215785530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARRA ALLEN Owner 678-777-4992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-05-10 |
| Last Update Date | 2024-05-10 |