| NPI | 1043319072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG MCGRAY Administrator 386-252-6438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1188) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2008-06-27 |