| NPI | 1083919500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE JEAN RICHARDS Office Manager 239-432-9383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5735) |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2011-01-13 |