INTEGRATED DERMATOLOGY OF PONCHATOULA, LLC

PONCHATOULA, LA
NPI1508234600
Entity TypeOrganization
Authorized ContactJEFFREY QUEEN
Manager
561-314-2000
Organization Subpart ?No
Primary Taxonomy207N00000X Dermatology
Enumeration Date2015-09-04
Last Update Date2019-05-21
Business Address
INTEGRATED DERMATOLOGY OF PONCHATOULA, LLC
180 N 5TH ST
PONCHATOULA, LA 70454-2532
Phone number: 985-370-7546
Mailing Address
INTEGRATED DERMATOLOGY OF PONCHATOULA, LLC
4700 EXCHANGE CT STE 110
BOCA RATON, FL 33431-4450
Phone number: 561-314-2000