| NPI | 1255766788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT MOISTER Owner 864-697-2009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 36140) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2018-07-18 |