NPI | 1942757547 |
---|---|
Entity Type | Organization |
Authorized Contact | JOSEPH DELANE MAGEE Owner 678-462-5628 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MS 1226) |
Enumeration Date | 2016-09-01 |
Last Update Date | 2016-09-01 |