| NPI | 1609448802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SWANSON Manager 951-738-0968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2021-07-15 |