| NPI | 1922128875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAVIER A LOPEZ CISNEROS Administrator 404-735-8641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 150425LGB) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2020-08-22 |