| NPI | 1396708087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARITY Q BOULTON Practice Administrator 770-442-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2020-08-22 |