| NPI | 1972658706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT EDWIN DIFABIO Preseident 3016-904-0870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MD A1166) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-08-22 |