| NPI | 1912087206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESI BEAMON MACKEY Practice Administrator 540-371-7726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |