| NPI | 1629018007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOHN LOOP Clinic Director 770-985-5223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA CHIR007718) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-08-22 |