| NPI | 1689083347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY BENICH Owner 770-924-0157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: GA 7987) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2014-08-07 |