| NPI | 1356504211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PRINS Credentialing Manager 909-307-8503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME84988) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2009-04-09 |