| NPI | 1770605214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL LEE GONZALES Practice Manager 907-222-9129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AK 02-C0001005) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2015-10-01 |