| NPI | 1215562236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTINA RENE RANDALL Owner 267-934-6996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-03-10 |