| NPI | 1144333105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA LYNNE O'DONNELL President 386-673-0517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL OS7905) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-08-22 |