| NPI | 1568808731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIDIA MOSQUERA Owner 770-849-0206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 2013005065) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: GA 2013005065) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |