| NPI | 1215069166 |
|---|---|
| Former Legal Business Name | RODERIQUE SURGI-CENTER, INC. |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BASILLE Owner 678-701-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: GA 060-096) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2021-04-01 |