Organization
SE COSTAL LASER SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANN EVANOSKI (BILLING MANAGER)
(520) 547-4130
Entity
Organization
Contact information
Practice address
2351 COLLEGE STATION RD, ATHENS, GA 30605-3619
(520) 547-4130
(520) 258-0304
Mailing address
6339 E SPEEDWAY BLVD, SUITE 201, TUCSON, AZ 85710-1147
(520) 547-4130
(520) 258-0304
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
01/31/2008
Last updated
06/06/2008
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