| NPI | 1104050517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONRAD FRITZ CEAN Medical Director 800-975-5109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NY 225389) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2009-05-13 |