| NPI | 1922823095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM VANDERVEER Managing Member 551-999-9064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2025-03-10 |