| NPI | 1861954083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L JACKSON Senior Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0200X Clinic/Center, Radiology |
| Additional Taxonomies | 261QM1200X Clinic/Center, Magnetic Resonance Imaging (MRI) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2022-07-28 |