| NPI | 1457690554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA BANKS Office Mgr 678-235-2401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2013-02-08 |