| NPI | 1881961050 |
|---|---|
| Former Legal Business Name | WILLOW MEDICAL SPA FOR WOMEN LLC |
| Entity Type | Organization |
| Authorized Contact | DANA L HIGGINS Owner 541-653-9158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA MD22056) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2017-09-07 |