| NPI | 1477004430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL M MCKENNA Director 800-750-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 202174) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |