| NPI | 1639571532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN B COOPER Sole Member 855-880-7568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 031143) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2015-05-07 |