| NPI | 1578004743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA THERRIEN Administrator 800-660-6030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2017-03-20 |