| NPI | 1003965328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID W ODELL Authorized Official 888-282-7472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA 220000492) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-01-07 |