| NPI | 1689927576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAFAYETTE G OWEN Owner 812-218-8927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: KY 13257) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2018-04-18 |