| NPI | 1770911463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY WILLIAM RUBIN Owner 770-516-7880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 208VP0014X) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2014-06-18 |