| NPI | 1902494271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER LEE CLERK Owner 872-215-0850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2021-01-04 |