| NPI | 1689189854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA NATALIE QUELLER Medical Director 424-208-3251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A127029) |
| Enumeration Date | 2017-12-09 |
| Last Update Date | 2017-12-09 |