| NPI | 1124491816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN EDWARD TERWILLEGER President 386-851-0644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME0045959) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2015-11-04 |