| NPI | 1073093175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALLAS R. BUCHANAN Owner/Provider 833-284-8439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME134199) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-11-27 |