| NPI | 1194105973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS GRACE LANE President, S Corp 831-688-8333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-06-05 |