| NPI | 1356503122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEAGHAN OLMSTEAD Surgical Administrator 855-377-3782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AZ 37978) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2020-06-15 |