| NPI | 1356538961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KITTI K OUTLAW President Owner 251-414-1333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AL 00018171) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2019-03-04 |