| NPI | 1407006018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLUSOLA O ODUNTAN Owner 276-596-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101240724) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: VA 0101240724) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2008-09-19 |