| NPI | 1417294174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY KYLE GAMBRELL Director/CEO 267-456-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CA C3527438) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |