| NPI | 1215986609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK B. KUKLER Owner 678-985-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0800X (Licence: GA 067-200) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-11-28 |