| NPI | 1922059195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY DEAVERS Administrator 251-943-6736 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0200X Clinic/Center, Radiology (Licence: AL 06800) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2010-01-11 |