| NPI | 1376935023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONG BAO NGUYEN Registered Agent 770-557-8788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: GA 14006863) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2015-03-03 |