| NPI | 1033468442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENETA C DEWEY Billing Specialist 870-421-1424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2024-10-22 |