| NPI | 1164676771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH MICHAEL CHARL3S Owner 386-365-3845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME82558) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2008-11-10 |