| NPI | 1104092345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERT THOMAS HAMMOND CEO 239-334-9555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2022-01-20 |