| NPI | 1255970265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC BARKER President 605-876-7653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2019-12-23 |