| NPI | 1609983477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN V KELLOGG Executive Director 770-479-5535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-08-22 |