| NPI | 1871911511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA M POULOS Owner/Provider 508-393-4544 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 78672) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2014-10-22 |