| NPI | 1013011584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EDWARD MCDONNELL Owner/Physician/President 386-677-6727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0058254) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2020-08-22 |