| NPI | 1982958450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARON C PRAETZEL Owner 5016-234-4858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AR 3759) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2012-11-05 |