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 |