| NPI | 1982881611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RUSSELL SPARENBERG Owner 972-867-2522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX c9674) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2016-03-29 |