| NPI | 1083936058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDELL O BLAKE President 863-683-5567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME0030612) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME 0016779) |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2010-08-25 |