| NPI | 1639422108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH ALLEN PERRINE Owner 937-554-7573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2013-03-08 |