| NPI | 1134371933 |
|---|---|
| Doing Business As | SPACE COAST IPA |
| Entity Type | Organization |
| Authorized Contact | CRAIG K DELIGDISH Board Member 321-727-3495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2010-07-30 |