| NPI | 1053768309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANISHUA M ROBERTS Manager 678-515-4607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-05-17 |