| NPI | 1528084787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY A STUCKEY Billing Manager 251-631-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL 13229) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-08-22 |