| NPI | 1780936252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CESAR LOOR Physician Assistant 678-880-6879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA 00658) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA 160312) |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2012-10-10 |