| NPI | 1528889755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE KING Owner 541-292-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2024-10-21 |