| NPI | 1336561133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HERBERT LOUIS COUSIN Owner 770-875-1243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 4019) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-01-13 |