| NPI | 1104829597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER D HOGAN Owner 228-896-1120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MS 25C0001038) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-03-20 |