| NPI | 1790939726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK DON DIEGO Program Director 770-968-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: GA 001800) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2008-11-04 |