| NPI | 1659565562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANTHONY LONG President 770-429-1005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 0048265) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |