NPI | 1043215643 |
---|---|
Entity Type | Organization |
Authorized Contact | FAITH Y TRADD Practice Administrator 386-822-9410 |
Organization Subpart ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: FL ME36213) |
Enumeration Date | 2005-06-20 |
Last Update Date | 2008-07-14 |