| NPI | 1962164269 |
|---|---|
| Other Name | DIVINE DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | JENNIFER MICHELLE DIVINE Owner 970-286-2668 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2021-10-13 |