| NPI | 1336457449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BASIL ODUSANYA Director 770-909-4564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 031012761) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2010-09-23 |