| NPI | 1063823854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN R WESTBERRY Physician Owner 772-978-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: FL ME64071) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: FL ME78173) |
| 261QP2300X Clinic/Center, Primary Care (Licence: FL ME64071) | |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2014-05-16 |