| NPI | 1043290653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM S. MARRERO Credentialing Specialists 239-215-6884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2024-07-12 |