| NPI | 1194277210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT ISAAC RICHARDSON Owner 229-224-4858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 055328) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |