| NPI | 1346316817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES J STIEN M.D 0951-496-7583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1102X Clinic/Center Military Outpatient Operational (Transportable) Component (Licence: MA 15844) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-08-22 |