| NPI | 1750700753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH LAMAR LESLIE Pharmacy Manager 678-472-2971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: GA RPH027064) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2014-04-08 |