NPI | 1740674464 |
---|---|
Entity Type | Organization |
Authorized Contact | KYLE KIT SHADDIX Manager 904-316-1515 |
Organization Subpart ? | No |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME99596) |
Enumeration Date | 2015-03-19 |
Last Update Date | 2015-03-19 |