| NPI | 1891245692 |
|---|---|
| Doing Business As | THE CANCER CENTER AT PROVIDENCE PARK PET CT |
| Entity Type | Organization |
| Authorized Contact | ERICA MADISON Credentialing Specialist 251-342-3949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |