| NPI | 1366640039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY HEATH WESTCOTT Fiscal Officer 01181611-743-2021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1101X Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2008-08-07 |