Organization
RADIANCE LIGHT SYSTEMS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON MICHAEL CISSELL (OWNER)
(404) 819-1432
Entity
Organization
Contact information
Practice address
2145 ROSWELL RD, MARIETTA, GA 30062-0821
(770) 565-8266
Mailing address
2145 ROSWELL RD, MARIETTA, GA 30062
(770) 565-8266
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
140922
GA
Other
Enumeration date
11/04/2013
Last updated
11/04/2013
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