| NPI | 1871542787 |
|---|---|
| Former Legal Business Name | WATER'S EDGE DERMATOLOGY, INC |
| Entity Type | Organization |
| Authorized Contact | SUSAN DAVIS Dir Billing Operations 561-693-0540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: FL 800019024) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2016-01-27 |