| NPI | 1023039195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD C CAPE Owner 731-285-1545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TN 184) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-08-22 |