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 |