| NPI | 1467288530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARION YORK Credentialing Specialist 501-246-4561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-09-13 |
| Last Update Date | 2025-04-21 |