| NPI | 1477806354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA S COLLERAN Owner 319-339-3872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA 37357) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: IA 37357) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2012-10-17 |