| NPI | 1366724825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM L THORNSON Owner 774-202-7049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MA 1138975) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2011-09-12 |