| NPI | 1023394707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNETTE A TARNOWSKI Office Manager 386-736-7244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0066309) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2011-10-26 |