| NPI | 1245340603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY BURTON Manager 877-969-0392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TN 152) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-08-02 |