| NPI | 1659596682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT MICHAEL MAGLIOCCO President Owner 770-591-3511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA Ga2071) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |