| NPI | 1700251436 |
|---|---|
| Doing Business As | 23RD AVENUE DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | LESLIE CAUDILL Md 270-776-2328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 49471) |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2015-12-09 |