| NPI | 1306194873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR HARLEY GREGORY Owner 239-980-4664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0200X Clinic/Center, Radiology (Licence: FL L09000051092) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2022-07-21 |