| NPI | 1730380775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VETRA A GIPSON Owner 404-805-0646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 50518) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2011-04-11 |