| NPI | 1518011790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX CAMPOS Owner / President 678-812-2625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 183500000X Pharmacist |
| 207QA0000X Family Medicine, Adolescent Medicine | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-01-22 |