| NPI | 1144690868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN P MOORE Owner 386-719-5656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL ME106629) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |