| NPI | 1053762740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ALLEN OSBORNE Owner 386-283-5997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME101968) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2022-07-21 |