| NPI | 1417192022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL R NOBACK Member 941-360-1566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1176) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2017-01-10 |