| NPI | 1780712364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARID U QAZI Physician 478-275-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: GA 1154208) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |