| NPI | 1386121580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANNERY SIOELI LAUVAO Owner 520-979-7095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2024-08-11 |