| NPI | 1003163320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD J FORNACE Physician 386-441-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2012-08-06 |