| NPI | 1871877159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELO LORENZO HOLT Executive Director 404-914-1912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |