| NPI | 1013338144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA HELEN MIKULA Medical Director 386-677-5415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: FL ME47765) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2014-04-23 |