| NPI | 1578110623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE JOHNSON Manager 915-319-3735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 208200000X Plastic Surgery |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2019-08-23 |