| NPI | 1104562354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE SHANNON Office Manager 725-210-7967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-05-10 |