| NPI | 1043525546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD DOUGLAS TESTERMAN Owner 941-400-1901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9102238) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2011-07-27 |