| NPI | 1629405964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS RAFAEL VIZCARRA-FALLA Medical Director 678-615-2565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 68630) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2013-10-01 |