| NPI | 1720303092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY UNDERDUE Executive Director 770-389-9886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2010-03-30 |