| NPI | 1649314212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA M ADAMS Manager 386-615-1771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME69303) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2023-01-24 |