| NPI | 1326066010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY D PROFFITT President 251-607-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2015-01-27 |