| NPI | 1366935165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN MATOS Managed Care Sales COO Rdinator 678-892-3771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2018-06-07 |