| NPI | 1588812465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUC THIEN DUONG Owner 678-644-9949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 08-8073) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-04 |