Organization
AESTHETIC SURGERY CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY RICHARDSON (VICE PRESIDENT)
(228) 392-4454
Entity
Organization
Contact information
Practice address
1720A MEDICAL PARK DR, SUITE 140, BILOXI, MS 39532-2129
(228) 392-4454
(228) 392-4533
Mailing address
PO BOX 6066, GULFPORT, MS 39506-6066
(228) 392-4454
(228) 392-4533
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
11075
MS
Other
Enumeration date
07/19/2011
Last updated
10/19/2011
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