| NPI | 1255600565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIO MENDOZA Clinic Manager 770-928-8450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: GA LC20110001409) |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2012-06-21 |