| NPI | 1104005859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN S DAITCH Physician 239-437-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL BD1688641) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2008-12-03 |