| NPI | 1063442077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ANN ROYBAL Administrator 571-209-6465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: VA OH700) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-07-22 |