| NPI | 1689920977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA LYNN DITTHARDT Office Manager 954-964-4113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2012-07-24 |