| NPI | 1073911236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK FEDOK Owner President 251-943-6003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AL 15147) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: AL 15147) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2017-08-14 |