| NPI | 1003098252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA NORSWORTHY Practice Manager 207-370-3105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2024-07-01 |