| NPI | 1083985873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEDE SIEBENALER Office Manager 386-767-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0029698) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |