| NPI | 1467572321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE JUAN BACALLAO Director 404-735-9844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 139625LGB) |
| Enumeration Date | 2007-04-01 |
| Last Update Date | 2020-08-22 |