| NPI | 1912315763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK PAUL TANNER Owner/Licensed Csa 386-960-4534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2016-03-04 |