| NPI | 1700026812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN B FIZTGERALD Medical Director And Owner 264-864-0023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2009-03-02 |