| NPI | 1205195716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HOLST President, Board Of Managers 6153-456-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2016-04-05 |