| NPI | 1306924170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE J STACK Director Of Billing 774-320-3040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: MD D0036586) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-02-06 |