| NPI | 1013289859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE A IDICULLA President 321-638-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0066869) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2013-07-30 |