| NPI | 1831369610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN M. RUSSELL President 386-447-4440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: FL PENDING) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2008-06-09 |