| NPI | 1235508342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASIF A LALA Owner 912-675-8468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MS 3785-15) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2016-03-18 |