| NPI | 1043583370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN WALLICK Clinic Manager 239-949-3045 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL F11000003392) |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2014-12-22 |