| NPI | 1962753699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY DWYER Executive Director 678-973-7358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL 80-0831636) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |