Organization
GRACE DERMATOLOGY & MICROGRAPHIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE LELAND HORNER MD (OWNER)
(206) 465-8046
Entity
Organization
Contact information
Practice address
2500 S MAIN RD, LEBANON, OR 97355-2336
(206) 465-8046
Mailing address
2500 S MAIN RD, LEBANON, OR 97355-2336
(206) 465-8046
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
MD153145
OR
Other
Enumeration date
09/07/2012
Last updated
11/26/2012
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