| NPI | 1265882096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNEH BACKSTRAND Md 239-338-7074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL me0050622) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |