| NPI | 1992467682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA MARIE HRUSKA Owner 618-616-1658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2021-10-10 |
| Last Update Date | 2021-11-14 |