| NPI | 1144635426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERI ANN KSIAZEK Office Manager 239-334-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 0020292) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |