| NPI | 1023550654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA REGAN Physician 804-379-0116 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101238821) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2018-09-07 |