| NPI | 1689021420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNINGS RUSSELL BOYETTE Owner 501-205-8610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AR E-7894) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |