| NPI | 1790922680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN M HANSEN Owner 228-385-5350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: MS 16735) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2013-03-20 |