| NPI | 1972062685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE BARTLETT Adminstrator 833-367-4968 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-07-26 |