| NPI | 1548710155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BYRON DEEN Owner 478-845-3515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: SC MD31662) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |