| NPI | 1770616963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYBALAN R MOODLEY Owner 740-383-2776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2014-05-29 |