| NPI | 1205368453 |
|---|---|
| Doing Business As | RENEW DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | KELLY BALLOU Managing Member 309-287-1909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CO PA0004388) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |