| NPI | 1225579485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH WIERSZALOWSKI Administrator 251-544-6407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2021-03-18 |