NPI | 1790066967 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHN S. BRUNO President 239-936-2522 |
Organization Subpart ? | No |
Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME13183) |
Enumeration Date | 2011-09-01 |
Last Update Date | 2011-09-01 |