| NPI | 1679879654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS POTYONDY Medical Doctor/Manager 229-228-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 057743) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2011-02-08 |