| NPI | 1811367097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGARET SPAIN Administrator 678-820-7976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2015-10-01 |