| NPI | 1457613192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE WYNN KALLAY Owner 478-737-7653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 018950) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: GA 041044) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-06-15 |