| NPI | 1043434947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN THERESE MELVIN Owner/President 772-569-6869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME41899) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2018-07-13 |