| NPI | 1306630801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN LE Clinic Director / Owner 678-268-8891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2025-04-08 |
| Last Update Date | 2025-07-11 |