| NPI | 1558003764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA BROWN Chief Financial Officer 984-974-1145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-04-08 |