Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgery, Foot & Ankle |
213ES0103X | 48 | Podiatry |
| NPI Number | 1356892392 |
| LBN Legal business name | ADVANCED ANKLE AND FOOT CENTER, LLC |
| Authorized official | VILAYVANH SYSOUNTHONE - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/14/2016 |
| Last updated | 08/15/2018 - About 8 years ago |
| Identifiers | n/a |
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