| NPI | 1124323258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES M PORCELLI Owner 239-598-9327 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME 77513) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2011-01-20 |