| NPI | 1982637492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA LOU BEDWELL Administrator 386-672-7575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1251) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-08-22 |