| NPI | 1184022485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAIGE C. SWINDLE Office Manager 769-300-4055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MS 19109) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2015-10-08 |