| NPI | 1174502561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES A AMAN Executive Director 605-665-7841 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: SD 11145) |
| Additional Taxonomies | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2018-05-21 |