| NPI | 1962587741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK R GROOVER CEO 904-398-7205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: FL 2217) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-22 |