| NPI | 1780986125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEXTER T TODMANN Physician 800-709-2796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: GA 22067) |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2010-11-17 |