| NPI | 1912728007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN BARNETT Administrator/Authorized Official 870-508-1009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2025-06-20 |