| NPI | 1437308889 |
|---|---|
| Doing Business As | SKIN DEEP LASER & VEIN |
| Entity Type | Organization |
| Authorized Contact | MARK IDSTROM President 913-599-6777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2009-07-08 |