| NPI | 1043565948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA ROOD Sr It Syst EMS Analyst 234-312-5193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2023-07-24 |