| NPI | 1104452804 |
|---|---|
| Other Name | DIVINE DERMATOLOGY AND SURGICAL INSTITUTE |
| Entity Type | Organization |
| Authorized Contact | JENNIFER MICHELLE DIVINE Owner 970-286-2668 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-03-14 |