| NPI | 1740315332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM LADELL LUSTER Surgical Assistant 1224-399-9317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238.000125) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |