| NPI | 1225568884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORRIE MASSEY Chief Administrative Officer 833-283-5487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2018-03-01 |