| NPI | 1831379924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLORISSAL RENEL ALCANTARA President 404-246-1141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 621610) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2007-11-06 |