| NPI | 1205859550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON EDGAR WUEBBOLT Owner/Md 716-484-6700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: PA 20821501) |
| Additional Taxonomies | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: PA MD052930L) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-10-21 |