| NPI | 1902487903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIARA GROSS Owner 678-595-7483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |