| NPI | 1730355595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SURESH CHAVAKULA Medical Director 239-482-2280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 996) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2009-07-10 |