| NPI | 1083618656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL A CAVANAGH Administrator 386-738-6811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 809) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2008-04-01 |