| NPI | 1811289358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARD STEPHEN GRAND Partner 3864-535-9466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL CH2533) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: FL CH6374) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2011-05-03 |