| NPI | 1104047596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL WESLEY WALLACE Medical Director 310-652-8460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A49918) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-10-16 |