| NPI | 1598965634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERENDA TIMBERLAKE Administrator 386-487-3930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1046) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2017-03-31 |