| NPI | 1780852921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA BRAZELL BASS Owner 404-814-0733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 031559) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2008-02-11 |