| NPI | 1265694376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOIS WAGSTROM Owner 615-329-1822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN MDO21252) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2008-08-11 |