NPI | 1851701783 |
---|---|
Entity Type | Organization |
Authorized Contact | JENNIFER L JACKSON Sr Director Provider Enrollment 877-892-9815 |
Organization Subpart ? | No |
Primary Taxonomy | 261QR0200X Clinic/Center, Radiology |
Enumeration Date | 2014-04-30 |
Last Update Date | 2022-02-14 |