| NPI | 1225495435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY E TISSERAND Owner 812-476-1379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: IN 01037184) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |