| NPI | 1619010113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NOEL FRAZIER FERGUSON Owner 870-741-9481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: AR C-4026) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-08-22 |