| NPI | 1376863977 |
|---|---|
| Former Legal Business Name | ANCIENT CITY VEIN & VASCULAR, INC |
| Entity Type | Organization |
| Authorized Contact | JAMES ST. GEORGE CEO 904-402-8346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Additional Taxonomies | 202K00000X (Licence: FL ME88184) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2020-09-09 |