| NPI | 1114175122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY W SMART Owner/President 207-774-7242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: ME CR594) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |