| NPI | 1518172568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM SIDNEY ROBERT ROSS Owner 228-355-0719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 12739) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2008-05-22 |