| NPI | 1518112275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL J. LODGE Director Of Finance 267-960-1409 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2008-11-22 |
| Last Update Date | 2008-11-22 |