| NPI | 1508824293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS DAVID POTYONDY Managing Member 229-589-2588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD 60288108) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2012-09-11 |