| NPI | 1407932619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHMOND ROESKE Physician/Owner 800-345-8979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: CA 240000525) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2025-02-14 |